July 2024
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Jul 31 2024
Keith Wrenn Always Said, “Presyncope IS Syncope.” He Was Right
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This systematic review found that approximately 4%-27% of patients presenting to the ED with presyncope experienced serious outcomes within a 30-day period.Source
Serious outcomes among emergency department patients with presyncope: A systematic review. Acad Emerg Med. 2024 Jun 9. doi: 10.1111/acem.14943. Online ahead of print. PMID: 38853536 -
Jul 30 2024
Povidone Iodine vs Chlorhexidine Gluconate for Skin Prep
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Povidone iodine was shown to be noninferior to chlorhexidine gluconate in the preparation of intact pre-operative skin and prevention of surgical site infections (SSIs).Source
Povidone Iodine vs Chlorhexidine Gluconate in Alcohol for Preoperative Skin Antisepsis: A Randomized Clinical Trial. JAMA. 2024 Jun 17:e248531. doi: 10.1001/jama.2024.8531. Epub ahead of print. PMID: 38884982; PMCID: PMC11184497. -
Jul 29 2024
Administering Harm – A Deep Dive into Hospital Headaches
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Source Identifying and Measuring Administrative Harms Experienced by Hospitalists and Administrative Leaders. JAMA Intern Med. 2024 Jun 24:e241890. doi: 10.1001/jamainternmed.2024.1890. Epub ahead of print. PMID: 38913371; PMCID: PMC11197021.
There are significant administrative burdens faced by hospitalists and administrative leaders, which negatively impact efficiency, well-being, and job satisfaction. The findings highlight the importance of systematically identifying and measuring administrative burdens as a critical step towards creating healthier work environments, thereby optimizing healthcare delivery. -
Jul 26 2024
Is High-Sensitivity Troponin Actually Helping Us?
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This RCT of U.S. patients being evaluated for acute MI using a 0/1 hour hs-cTnI protocol, compared to standard care with a 0/3 hour hs-cTnI protocol, didn’t find a difference in the percentage of patients discharged from the ED nor in the rates of 30 day death or MI.Source
Rapid Acute Coronary Syndrome Evaluation Over One Hour With High-Sensitivity Cardiac Troponin I: A United States-Based Stepped-Wedge, Randomized Trial. Ann Emerg Med. 2024 Jun 15:S0196-0644(24)00235-X. doi: 10.1016/j.annemergmed.2024.04.024. Epub ahead of print. PMID: 38888531. -
Jul 25 2024
I Don’t CIWA We Can’t Use RASS Instead
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The first direct comparison of the Clinical Institute Withdrawal Assessment-Alcohol Revised (CIWA-Ar) scale to a slightly modified Richmond Agitation and Sedation Scale (mRASS-AW) in a pre-post quality assurance study found mRASS-AW to not compromise length of stay or safety for the evaluation of alcohol withdrawal syndrome (AWS), while we already know it to be faster and more intuitive.Source
Replacing the Clinical Institute Withdrawal Assessment-Alcohol revised with the modified Richmond Agitation and Sedation Scale for alcohol withdrawal to support management of alcohol withdrawal symptoms: potential impact on length of stay and complications. CJEM. 2024;26(6):431-435. doi:10.1007/s43678-024-00710-7 -
Jul 24 2024
What NOT to Use for Syphilis? Azithromycin Resistance Skyrockets
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Treponema pallidum, the bacteria that cause syphilis, has nearly universal (99.2%) resistance to azithromycin. Use penicillin in these patients.Source
Near-Universal Resistance to Macrolides of Treponema pallidum in North America. N Engl J Med. 2024 Jun 13;390(22):2127-2128. doi: 10.1056/NEJMc2314441. PMID: 38865666 -
Jul 23 2024
Medical AI – You Reap What You Sow
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This thoughtful review illustrates how human biases and ethical assumptions impact medical AI models, as outputs are based on the training data ingested, human fine-tuning to optimize responses, and the nature and perspective of prompts used. As such, the authors recommend caution in the application of AI to medical decision making.Source
Medical Artificial Intelligence and Human Values. N Engl J Med. 2024 May 30;390(20):1895-1904. doi: 10.1056/NEJMra2214183. PMID: 38810186. -
Jul 22 2024
The Future of AI for EM – It’s Kind of Exciting!
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Emergency medicine practice is going to be increasingly influenced by artificial intelligence (AI). This article discusses some of the ways we can expect it to impact our practice.Source
The AI Future of Emergency Medicine. Ann Emerg Med. 2024 May 22:S0196-0644(24)00043-X. doi: 10.1016/j.annemergmed.2024.01.031. Online ahead of print. PMID: 38795081 -
Jul 19 2024
Anatomically vs Physiologically Difficult Airways
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An analysis of the NEAR database demonstrated a lower first-pass success rate of 89.2% for patients with anatomically difficult airways (ADA) compared to 93.7% in the control group. First-pass success for physiologic difficult airways (PDA) was 92.9% and fell to 87.4% for those with both ADA/PDA.Source
First-Attempt Success Between Anatomically and Physiologically Difficult Airways in the National Emergency Airway Registry. Anesth Analg. 2024;138(6):1249-1259. doi:10.1213/ANE.0000000000006828 -
Jul 18 2024
Does Topical Diclofenac Work for Acute Low Back Pain?
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Unfortunately, topical diclofenac did not demonstrate substantial pain control and provided no added benefit, even when co-administered with oral ibuprofen for specific patients with acute low back pain.Source
Topical Diclofenac Versus Oral Ibuprofen Versus Diclofenac + Ibuprofen for Emergency Department Patients With Acute Low Back Pain: A Randomized Study. Ann Emerg Med. 2024 Jun;83(6):542-551. doi: 10.1016/j.annemergmed.2024.01.037. Epub 2024 Mar 2. PMID: 38441515